Provider Demographics
NPI:1255352217
Name:DEMEKE, TESFAYE (MD)
Entity type:Individual
Prefix:
First Name:TESFAYE
Middle Name:
Last Name:DEMEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5154
Mailing Address - Country:US
Mailing Address - Phone:970-378-4529
Mailing Address - Fax:970-378-4531
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5154
Practice Address - Country:US
Practice Address - Phone:970-378-4529
Practice Address - Fax:970-378-4531
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODE678172OtherBCBS
CO92706037Medicaid
CO92706037Medicaid
CODE678172OtherBCBS
COBD7847518OtherDEA #
COC811581Medicare PIN